Emergence of Candida tropicalis resistant to caspofungin

Candida species is the fourth leading cause of nosocomial blood-stream infection in the USA. The incidence and mortality of invasive candidiasis (IC) remain high despite new antifungal agents. Although Candida albicans remains the most common isolated species causing IC, the incidence of IC caused by non-albicans species is increasing.1 Caspofungin, an echinocandin, is approved for treatment of IC.2 Resistance to caspofungin has been rarely reported. We admitted a 28-year-old female with acute myelogenous leu-kaemia (AML) for fever and otitis media. She was started on cas-pofungin [70 mg intravenous (iv) loading dose followed by 50 mg iv daily] on her fifth hospital day due to persistent fever despite iv broad-spectrum antibiotics. Defervescence was noted and she was started on induction chemotherapy for AML on the sixth hospital day. She again developed fever with symptoms of oesophagitis on her 21st hospital day. Oesophagogastroduodenoscop